Personality Disorder

Personality refers to the patterns that make up how we think, feel and behave towards the world. In a personality disorder, the ways in which a person thinks, deals with their feelings and behaves cause significant distress to themselves or others in many aspects of their life – for example, at work or in relationships. The person’s symptoms will be long-standing and enduring – in other words, probably dating from late childhood or adolescence and extremely hard for them to change. Quite often people have more than one personality disorder and may struggle with other mental health problems such as depression or substance abuse. Personality disorders may be caused by a mixture of upbringing, genetics and biology. It’s not uncommon for people to have experienced fear or distress in childhood through abuse in one form or another.

How do I know if I have a personality disorder?

There’s a lot of material on the internet which may give you an initial idea about personality disorders. Because diagnosing yourself (for example, doing a personality disorder ‘test’) can be unreliable, however, it’s always advisable to talk to a specialist. Your GP can be a helpful starting point in this.

Below are brief details of some of the more common types of personality disorder: borderline, narcissistic, histrionic, schizoid, obsessive compulsive, avoidant and dependent. Although I have drawn from many sources, including my own clinical experience, I have made particular use of the work of Otto Kernberg and of Nancy McWilliams in her book, Psychoanalytic Diagnosis.

Borderline personality disorder

More women than men suffer from borderline personality disorder (BPD). A person with the condition may swing between a fear of being abandoned by others and a fear of being engulfed. They may have unstable moods and difficulty in containing emotions including anger. They can shift rapidly from very good to very bad feelings about another person and shift rapidly too in how they see themselves. There may be feelings of boredom and emptiness and sometimes episodes of dissociation – ie periods of ‘lost’ time, trance-like states and forgetfulness. The person may be reckless and do things on impulse such as self-harming or attempting suicide. There can also be a pattern of unstable and intense relationships.

The causes of BPD are complex and often include childhood loss, trauma and abuse – physical, emotional (including neglect) or sexual. The experiences may have been overwhelming, unbearable or terrifying and may have rendered the child powerless and unable to process what they were feeling. A parent may have switched between being caring and being quite the opposite, making it impossible to develop a stable, integrated sense of self and others. Another factor may have been a mother who discouraged a small child’s natural drive towards independence and self-assertiveness and instead encouraged clinging behaviour. The child then grew up feeling safe in regressed, dependent relationships but which also threaten to engulf her or him. Aloneness, on the other hand, brings an anguished sense of abandonment.

Narcissistic personality disorder

Narcissistic personality disorder is characterized by a grandiose sense of one’s own importance and superiority, a feeling of being special, a craving for admiration, a sense of entitlement, a lack of empathy, strong envy, fantasies of power and success, the misuse and exploitation of others and a heightened sensitivity to criticism and shame. For more information, please see the separate page on narcissism.

Histrionic personality disorder

Histrionic personality disorder affects more women than men. People who have it tend to be over-dramatic, attention-seeking, intense, risk-taking, suggestible, anxious and seductive. They may be preoccupied with their appearance and have strong emotions which change quickly.

Often they may feel deep down like small, frightened children in a world of powerful adults. Their original family experiences may have led them to believe that females are weak and unimportant and that men are strong, exciting and dangerous. To master anxiety, they may run towards what they fear (behaving seductively with men, for example). They dramatize what they say because they don’t expect to be listened to as an adult. Much of this behaviour is unconscious.

Schizoid personality disorder

Those suffering from schizoid personality disorder usually keep away from emotional involvement with others. They may prefer their own company and have little interest in sex or intimacy. Some feel that relationships interfere with their freedom and they can appear detached, emotionally cold, overly intellectual and aloof. They’re often introspective with a complex inner world of fantasy.

One frequently finds that schizoid people have had impinging, overinvolved parenting which was perhaps combined with impatience and criticism. There may also have been contradictory communications. It’s not surprising that withdrawal was a solution. Alternatively, some children have had neglectful and lonely upbringings which set the pattern for the future.

Obsessive compulsive personality disorder

Individuals with obsessive compulsive disorder may exhibit hoarding behaviour, need to keep everything under control, be rigid, detailed and rule and routine-bound, dislike change, become anxious when mistakes are made, have unrealistically high standards, expect disaster when things aren’t perfect, be judgemental and sensitive to criticism, have obsessional thoughts and be excessively cautious.

The parents or caregivers of these people may have been over-controlling, stern or authoritarian, condemning not only ‘unacceptable’ behaviour but even thoughts and feelings. They may have induced guilt in a child or shame. The child may grow up with a tension between rage at being controlled and fear and shame about being punished. These feelings are buried beyond awareness. The person may keep things that way by talking about what they think rather than what they feel.

Compulsive actions (for instance, cleaning or shopping) may have the unconscious meaning of magical rituals to atone for guilty, aggressive thoughts. Acting compulsively may also be linked to a need to leap into action to avoid making a considered choice – a choice which could be wrong and risk guilt or shame. Similarly obsessive procrastination has the effect of putting off a choice. Paradoxically all the rigid behaviours may also conceal a wish to be irresponsible, messy and rebellious.

Avoidant personality disorder

An avoidant personality disorder means that someone may avoid social activity, feel socially inferior, have few or no friends or intimate relationships, worry about being ‘found out’, rejected or embarrassed, feel constantly tense and anxious and avoid risk. Unlike schizoid people, they are less likely to appear emotionally cold but rather they crave the relationships they can’t achieve.

The person’s parenting may have included absence, rejection or disciplinarian and controlling attitudes. The child’s confidence may have been undermined or not built up, leaving a fear of failure. Experiences of rejection by peers may have compounded things, along with other shaming experiences in social settings. The latter may have caused feelings of being out of control which, in turn, may symbolize wider fears of loss of control if frightening aggressive or sexual feelings were let out. As so often, much of this is likely to be happening at a level beyond conscious awareness.

Sometimes parenting which obstructs a child’s drive to separate emotionally and make his or her own way in life can also stunt the development of confidence. An interesting paradox may be that the fear of social rejection may cover a fear of actually being accepted with perceived risks of becoming dependent, controlled or trapped in committed relationships – which may already have been experienced in childhood. Similarly, fear of failure may mask a fear of being successful with the unfamiliarity and responsibilities that could entail.

Dependent personality disorder

People with a dependent personality disorder tend to be passive, allowing others to take responsibility for decision-making in their lives and requiring considerable help and reassurance if making decisions themselves. They may accede too easily to the wishes of other people even when those wishes feel wrong or uncomfortable, perhaps for fear of harming the relationship. They may struggle to make perfectly reasonable demands and have a sense of weakness, neediness, incompetence or helplessness. They may find it hard generally to function without support, lack confidence and view others as being much more capable. They may fear being left to fend for themselves.

Children learn, mature and become independent through experimentation. Two different parenting styles may work against this and create continuing dependency. Authoritarian parenting may prevent a child engaging in trial-and-error learning and growing in a sense of potency. Conversely, over-protective parenting which prevents a child’s natural emotional separation can do the same and habituate them to functioning only with the support and guidance of people who are experienced as stronger and more able. If the child is then also mocked by peers for incompetence and immaturity, that may reinforce the belief that life can only be successfully navigated by leaning on others rather than by trusting in one’s own resources. Anxious parenting may also make the fear of failure frightening and block the discovery that failure can be survived and learnt from.

What can be done to help with personality disorders?

A variety of treatments are available for personality disorders, including analytic psychotherapy. Sometimes another form of therapy, for example Cognitive Behavioural Therapy (CBT) or Dialectical Behaviour Therapy (DBT), may be required first in order to bring symptoms and behaviours under control.
When it comes to personality disorders there are no quick fixes. Certainly analytic psychotherapy is a gradual process often requiring quite lengthy work to get results. Although a successful outcome can’t be guaranteed, psychotherapy does have as its goal moderate but long-lasting change.

It’s important to be aware that whether or not I take someone into therapy will depend, among other things, on the level of their symptoms. If they are severe, more specialized help, for example provided by the NHS, would be more beneficial. GPs are always a good place to start in finding the right way forward and there are also local support groups, online support communities (including some specifically for people who self-harm), websites, blogs and self-help books.